On the Emergence of Tremor in Prodromal Parkinson’s Disease

Clinical, neuropathological and neuroimaging research suggests that pathological changes in Parkinson’s disease (PD) start many years before the emergence of motor signs. Since disease-modifying treatments are likely to be most effective when initiated early process, there has been significant interest characterizing prodromal PD. Some people with PD describe autonomic symptoms at time diagnosis suggesting dysfunction is a common feature Furthermore, subtle signs may present emerge prior diagnosis. We series patients who, phase PD, experienced tremor initially only while yawning or straining stool discuss how involvement brainstem nuclei could lead these previously unreported phenomena. The hypothalamic paraventricular nucleus (PVN) plays central role control including bowel/bladder function, cardiovascular homeostasis innervates multiple involved functions (including reticular formation, locus ceruleus, dorsal raphe vagus). PVN affected evidence from related phenomena suggest increase either by increasing downstream cholinergic activity on such as formation stimulating ceruleus activate cerebellothalamocortical network via ventrolateral thalamus. Aberrant cholinergic/noradrenergic transmission between couldlead other parkinsonian signs, representing an clinical clue